Rivers Lugg & Teme
Park at the B4362 bridge at Mortimer’s Cross layby. Cross the bridge and take the footpath over a stile, across two fields and a low hill into which the river cuts. About half a mile downstream the path descends into a water-meadow, and the river meanders between shingle banks. There are few deep pools – it’s impossible to get out of your depth – but it’s private. We met no-one on a sunny Saturday in June. Grid reference SO428634
The stretch of Lugg upstream of the A4110 bridge (around SO420656) is also allegedly good, but the river in front of the Riverside Inn didn’t look enticing and I couldn’t get access from the north bank.
Just upstream of Leintwardine bridge at the junction of the Teme and Clun is a well-known spot (click here), but I didn’t know about that. The pool below the weir and road bridge looked enticing, but public.
Instead I followed the minor road downstream past “The Sun”, a traditional pub. Immediately after passing a small factory right, a footpath runs to the river. The deep pools in the meanders, easily accessible from shingle banks, are very private. Grid reference SO478736
This stretch is labelled on the Ordnance Survey as Leintwardine Fishery, but we saw no fishermen in June. Downstream of Ludlow there is said to be a good spot at SO532687, accessible from the footpath from the A456, but not personally tested.
Britain’s most popular 20th century poet is long overdue his place in Poets’ Corner. The nincompoops who fret that he liked a bit of porn and wrote some letters that don’t pass muster with today’s thought police, have been pushed aside by admirers of Wedding Wind, Church Going and The Whitsun Weddings. Not to mention the millions who know the first line of This be The Verse.
The unveiling will be on Dec 2 2016. Surely there won’t be a service; not for the man who called religion “that vast moth-eaten musical brocade/Created to pretend we never die”. But which poem will they read? Not one of the “Weddings”. Not High Windows; it’s a little soon for the “F word” in Westminster Abbey. Perhaps Church Going. But I’d vote for the one that ends with Larkin’s most puzzling line; the one read out at funerals, and quoted by Anthony Lane after the Twin Towers fell on 9/11. The line that was almost meant and almost true.
An Arundel Tomb
Side by side, their faces blurred,
The earl and countess lie in stone,
Their proper habits vaguely shown
As jointed armour, stiffened pleat,
And that faint hint of the absurd–
The little dogs under their feet.
Such plainess of the pre-baroque
Hardly involves the eye, until
It meets his left hand gauntlet, still
Clasped empty in the other; and
One sees, with sharp tender shock,
His hand withdrawn, holding her hand.
They would not think to lie so long.
Such faithfulness in effigy
Was just a detail friends could see:
A sculptor’s sweet comissioned grace
Thrown off in helping to prolong
The Latin names around the base.
They would not guess how early in
Their supine stationary voyage
Their air would change to soundless damage,
Turn the old tenantry away;
How soon succeeding eyes begin
To look, not read. Rigidly they
Persisted, linked, through lengths and breadths
Of time. Snow fell, undated. Light
Each summer thronged the grass. A bright
Litter of birdcalls strewed the same
Bone-riddled ground. And up the paths
The endless altered people came,
Washing at their identity.
Now, helpless in the hollow of
An unarmorial age, a trough
Of smoke in slow suspended skeins
Above their scrap of history,
Only an attitude remains:
Time has transfigured them into
Untruth. The stone finality
They hardly meant has come to be
Their final blazon, and to prove
Our almost-instinct almost true:
What will survive of us is love.
The third recent negative self-hypnosis in labour trial
Self-hypnosis is a popular method of pain relief in labour; it sounds like a good idea, it’s cheap, could probably be taught to many women, and is unlikely to have serious adverse side effects. But until recently there were only poor quality trials. Now suddenly there is a glut of good ones.
In 2014 we commented on two, a Danish trial (click here) and the Australian HATCH trial (click here). Both were prospectively registered, with a predefined primary endpoint, (epidural in the Danish trial, epidural or opiates in HATCH), hit their predetermined sample size and analysed everyone in an unbiased way, by intention to treat. Both were negative.
Now my friend Professor Soo Downe from Preston in Lancashire has reported on a third one, the Self Hypnosis in Pregnancy (SHIP) trial. Click here for the full report.
Again it was beautifully designed and conducted. Prospectively registered here. (The link states it was retrospective, but this seems to be a fault with the recently updated website; SHIP was registered well before any codes were broken or analysis was done.) The primary outcome was epidural use, and the planned sample size 300 per group. 680 women were eventually randomised (343 to self-hypnosis and 337 to control) and all were followed-up. Epidural use was 94/343 (28%) in the self-hypnosis group v. 101/337 (30%) in controls, odds ratio (OR) 0.89, 95% confidence interval (CI) 0.64–1.24. i.e. the self-hypnosis does not work.
The authors also measured 29 allegedly predetermined (only 10 were listed on the trial registration site) secondary outcomes of which 27 were not statistically significantly different. For some reason they were placed in a supplementary appendix; come on you BJOG editors, get your act together! Some slightly favoured self-hypnosis, e.g. breast feeding 44% v 39% OR 1.23, 95% CI 0.82 – 1.86, or prolonged neonatal admission 6.2% v 6.6%. OR 0.94, 95% CI 0.50-1.74). Others slightly favoured controls, e. g. Caesarean deliveries 25% v 23 %, OR 1.11, 95% CI 0.78-1.58), and three of the 4 stillbirths were in the self-hypnosis group. But none were statistically significant. Nor were there any significant differences in anxiety, depression or “impact of events” scores at 2 and 6 weeks postnatal. This is a clearly negative trial.
However, the authors (or BJOG) provided a tweetable abstract:
“Going to 2 prenatal self-hypnosis groups didn’t reduce labour epidural use but did reduce birth fear & anxiety postnatally at < £5 per woman”.
This is misleading. Self-hypnosis did not reduce fear & anxiety postnatally. It may have made a difference in the change in anxiety level between before and after labour and in the change in fear of birth between the two time periods, but these are very odd trial outcome measures. You can’t be anxious or fearful about birth after it has occurred. More importantly the change measures were not pre-specified among the secondary outcomes, they are dependent on a low postnatal response rate which was higher in the intervention than the control group, and the baseline scores for both measures were non-significantly higher in the hypnosis group at baseline, so some of the change is likely to be due to regression to the mean, i.e nothing to do with the treatment. At best the change scores are hypothesis generating for future studies.
Here’s a better tweetable abstract:
SHIP is the 3rd well-designed RCT to show that self-hypnosis is ineffective for pain relief in labour. But it is cheap & harmless.
At BB Sophia, a private maternity hospital
When BB Sophia, Stockholm’s second private maternity hospital, opened last year I applauded the increase in diversity, and anticipated competition driving up standards (click here). However, last week the Swedish TV channel 4 programme, Cold Facts, aired some serious allegations about safety there*.
The trouble stems from a birth on 24 August 2014. Gegie Boden had a difficult delivery, complicated by shoulder dystocia, and collapsed shortly afterwards. Recognition of her collapse was allegedly delayed, perhaps because staff were more concerned about the baby. She was soon transferred to the nearby state-run Karolinska hospital, where she died a week or so later. Doctors interviewed on the programme, none of whom apparently worked at BB Sophia, alleged that intensive care facilities were substandard, and that the rules for the levels of intensive care required in private maternity units had been made less stringent to allow the clinic to open.
BB Sophia’s owners reject these claims and state they not only had adequate facilities for short term intensive care, but also a formal agreement with the Karolinkska to transfer patients needing longer term care. The Inspektionen för vård och omsorg (IVO), the Inspectorate for Health and Social Care, is investigating, but has not yet reported.
About five mothers die, out of the 100,000 or so who give birth in Sweden each year, one of the lowest rates in the world, so one death in a unit delivering 4,000 babies annually, while tragic, is not in itself evidence of poor care. But a TV programme about it, quoting doctors publicly alleging substandard care, and aired before the official report is complete, suggests that private hospitals are under closer scrutiny than their government counterparts.
This may be a good thing. Unlike government hospitals, which are often “too big to fail”, private ones cannot afford to ignore public safety concerns. I hope I’m not naive, but I remain optimistic that independent health care providers will drive up standards in the long run.
By Robert Frost
Frost had been a faithful husband for 47 years but when Elinor died in 1938 the famous poet became fair game. Kay Morrison, the wife of a colleague, seduced him within the year. Frost, smitten by the contrast between Kay’s public persona – respectable wife, two children – and her passionate sexuality, urged marriage, but she would not leave Ted. Over the 25 years till Frost’s death the tangle became ever more complicated. This famous sonnet was written when it was fresh.*
The Silken Tent
She is as in a field a silken tent
At midday when the sunny summer breeze
Has dried the dew and all its ropes relent,
So that in guys it gently sways at ease,
And its supporting central cedar pole,
That is its pinnacle to heavenward
And signifies the sureness of the soul,
Seems to owe naught to any single cord,
But strictly held by none, is loosely bound
By countless silken ties of love and thought
To every thing on earth the compass round,
And only by one’s going slightly taut
In the capriciousness of summer air
Is of the slightest bondage made aware.
*Myers J. An Earring for Erring: Robert Frost and Kay Morrison. American Scholar (Spring 1996); 65 (2):219-41. Available here.
Opposite the Trout at Godstow
Overgrown but still loved and tended.
The well in the centre with a plaque to Ralph Austen.
Most trees labelled.
Next door the allotment from which the orchard was created, and at the back some beehives.
Ralph Austen was a 17th century nurseryman, cider maker, and early environmentalist from Oxford.
Updated list in HealthWatch
My list of “experts”, who repeatedly publish articles and give talks extolling the benefits of post-menopausal hormone replacement therapy (HRT) without mentioning their associations with the companies who manufacture and market such drugs, has just been published in HealthWatch newsletter 97. Here is a copy. Spring 2015 issue 97 optimized (2) My article is on page 3. Click here for HealthWatch itself. Click here and here for earlier lists. Click here for the original Cancun Conflicts list, and here for the Hot Flash Havoc list.
The official advice, from both the UK Medicines & Healthcare devices Regulatory Authority (MHRA) and the US Federal Drug Administration (FDA), remains:
Take HRT for symptoms only, in the lowest dose and for the shortest time possible, and never for health promotion.
If you come across any “expert” saying different, check out who’s paying them.